Análise espaço-temporal da leishmaniose visceral no Brasil

Abstract

Visceral leishmaniasis (VL) is an infectious disease caused by protozoa of the genus Leishmania, prevalent in tropical, subtropical and temperate regions. It has an estimated global incidence of 50,000 to 90,000 new cases annually, with the highest number of cases in Brazil, Africa and India. The objective of this study was to analyze the spatial-temporal distribution of VL in Brazil from 2010 to 2019. The first article is a mixed ecological study on the operational indicators of VL in Brazil, based on new cases, with information contained in the System Information on Notifiable Diseases (SINAN) from 2010 to 2019. The second article is an ecological study of time series of all hospitalizations due to VL reported in the Hospital Information System of the Unified Health System (SIH-SUS), by place of residence, for all Brazilian states in the period from 2010 to 2019. For the trend analysis, the Prais-Winsten model was used and for the spatial analysis, the Global and Local Moran indices. In the first study, 33,195 new cases of VL were confirmed in Brazil. An increasing trend (Coef = 0.020; p-value = 0.01) was observed in Brazil for co-infection with VL-HIV. The North region tended to reduce laboratory confirmation (Coef = -0.003; p-value < 0.001). The Midwest region had a decreasing trend for clinical cure (coefficient = -0.005; p-value = 0.012) inversely the ignored evolution (Coef = 0.028; p-value = 0.008). "High-high" clusters were identified for cure (global Moran = 0.309) and laboratory criteria (global Moran = 0.302). Article 2 recorded 24,259 hospitalizations for VL in 2010 and 2019. The lowest number of cases occurred in the state of Amapá (4 cases), while the highest number occurred in the state of Maranhão (3,601 cases). The highest hospitalization rates were observed in Tocantins and the lowest in Paraná. There was an increasing trend in hospitalization for VL in the states of Paraíba, Pernambuco, Alagoas, Rio Grande do Sul and Goiás, decreasing in the states of São Paulo, Mato Grosso, Mato Grosso do Sul and in the Federal District. The findings of this study suggest that assistance to patients with VL is influenced by space. The study of the spatial analysis of the operational indicators of VL made it possible to highlight the heterogeneity and the pattern of geographic distribution of these indicators throughout the country. The results presented reinforce that VL continues to be neglected in the country because it has a high number of cases and high rates of hospitalization. It is hoped that the results of this study can contribute to the improvement of health actions, providing elements for the elaboration of strategies with a view to reducing VL cases and, consequently, hospitalizations, by directing interventions in areas of greater risk , thus supporting management actions in public health.